Opportunities for Cross-Border Programming The Baltic Sea ‘Network of Excellence’ Project USAID SOTA course October 8, 2002

Epidemiological update UNAIDS has declared Eastern Europe and Central Asia a priority region for HIV/AIDS response.

Regional Approaches to an HIV Response are crucial: Patterns of HIV spread are regional phenomena Collective responsibility between nations needs facilitating Key stakeholders at country level need to be involved in regional planning.

The ‘Network of Excellence’ Project… Regional project operating in 5 sites: Estonia Latvia Lithuania St Petersburg, Russia Kaliningrad, Russia Supports goals of BSI Action Plan, adopted by the five sites, with international support: HIV prevention among IDUs STI prevention and care focusing on vulnerable groups Health promotion among vulnerable youth.

Priority areas revealed by assessments: Kaliningrad Lithuania Latvia Estonia St Petersburg  Twinning for scaling up health systems responses;  Focus on teenage rehabilitation and drug prevention, links with youth leisure/sports centers in resource poor settings – twinning Klaipeda-Kaliningrad;  Local support for data collection in Klaipeda.  IDU harm reduction and rehabilitation models  Training of family doctors to provide services to young IDU  Parents against drugs support groups  Methodological and IEC materials Exchange.  Expanded harm reduction services;  National and Region- wide training center for youth peer educators.  youth workshops;  sex worker interventions.  IT support for information dissemination.

Elements of “Regionality” within the Project Regional Advisory Committee (RAC) Exchange of information and expertise = cross-border linkages throughout Beginnings of a regional Knowledge Management System –Encourage effective strategic thinking –Development of replicable best practices

The Regional Advisory Committee Elected representatives from each of the five sites plus other major stakeholders/donors in the region Provides input into program design and funding allocation; Provides a framework for strategic planning and advocacy for the region as a whole, to attract further donor support.

Small Grants – Latvia, Estonia Estonia –3 subagreements funded Two youth interventions = 510 youth trained in 34 workshops One SW intervention Latvia –2 subagreements funded Youth peer education training materials -- now in draft IDU outreach work -- Over 3,000 outreach IDU contacts in greater Riga

Small Grants - Lithuania 2 subagreements funded –Lithuania AIDS Center – information dissemination – 8 e-bulletins issued and widely disseminated 2 issues of Between Us published –Klaipeda – youth center and outreach – Equipment for youth center procured

Small Grants - Kaliningrad 1 subagreement funded HIV/AIDS resource center, women’s clinic, youth center -- Resource center furnished and equipped; Repeat behavioral survey in SW done (’97, ’01, ’02) –31% always use condoms –38 % use regularly in last 3 years –93% report history of STI

Small Grants – St. Petersburg 1 subagreement funded Linking three main harm reduction projects with existing health service providers, creating IDU-friendly referral network – ‘Doctors We Trust’ project – –13% of 2118 “bus attendees” referred to specialists –46% actually went to referred physician –42 sought specialist care without referral –Potential impact for rest of NW Russia

The regional Knowledge Management System: Improve and implement design and use of information technology at each site, including regional website design; Facilitate production of essential best practice packages for potential skills building and replication at other sites; Can serve as a clearinghouse for behavioral and biologic surveillance data and survey designs.

What will this look like? Start-up = IT assessment, website development and management. Primarily electronic-based, using e-bulletins for distribution of information and a network of interlinked websites to manage and maintain HIV/AIDS information. Each website will be considered an information “node” for a specific theme or target group.

Knowledge Management System thematic ‘nodes’: Kaliningrad Lithuania Latvia Estonia St Petersburg Health systems responses Second generation surveillance IDU Behavior change M&E Electronic dissemination and e-learning; facilitation of links between existing networks (youth, men-who-have-sex-with-men and IDU). Youth methodologies Regional Advocacy, including links between Ministries of Justice, and work in prisons

Products: best practice and essential tools packages. Supplemented by technical training workshops to disseminate skills in addressing BSI goals and use of essential packages. System could be accountable to the RAC. Staff of the “nodes” could meet twice yearly concurrently with RAC. Support the System by means of production of a regular publication – preferably an e-bulletin based in one of the “nodes”?

Building stakeholder commitment Set-up and regional consensus building –Assessment and consensus-building = TOR of RAC and agreement on general goals –Site assessments, identifying local partners collaboratively, developing sub-agreements for most effective use of small grants –Local project director responds to USAID, Embassy and local counterpart needs on a daily basis, and liaises with other donors Maintain the momentum –Facilitate regular RAC meetings –Encourage secondary collaboration and strategic thinking (links to other donors, Global Fund proposal development, ongoing TA) –Continue implementation of grants, expand coverage via new recipients Value-added: global lessons adapted to local conditions = accelerated learning curve.

Constraints: –Dominant personalities = centralize donor and policymaker attention – how to spread the wealth? –Individual priorities overshadow regional interests –Lack of national strategies on HIV/AIDS –Competing interests – EU and NATO membership vs fighting low-prevalence HIV/AIDS.

Challenges for the Region: Expanding coverage yet sustaining current project activities, services and institutions.Expanding coverage yet sustaining current project activities, services and institutions. Defining next steps within national strategies.Defining next steps within national strategies. Strengthening cross border links and regional cooperation.Strengthening cross border links and regional cooperation. Accessing increased international funding, to build on regional co-operation.Accessing increased international funding, to build on regional co-operation.

Lessons Learned and Recommendations Regional team-building takes time. Direct funding of selected national projects should occur early on in a regional initiative to: Increase trust and motivation of individual countries; Kick-start regional collaboration, through practical consensus-building around small grants allocations. Benefits are clear: Commitment beyond borders; Regional goal setting Better preparedness for access to larger funding sources than can be attracted by individual countries/states; ‘The whole becomes more than the sum of its parts.’